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Pancreatic cancer

Definition
  • Pancreatic cancer refers to malignant tumours originating from the pancreas.
Etiology
  • Main types: Adenocarcinoma (arising from exocrine cells, most common) and neuroendocrine tumours (less common).
  • Risk factors:
    • Chronic pancreatitis.
    • Smoking.
    • Obesity.
    • Family history of pancreatic cancer or certain genetic mutations (e.g., BRCA2, PALB2).
    • Diabetes.
    • Age > 60.
Clinical Presentation
  • Often asymptomatic until advanced stages.
  • Jaundice (particularly with tumours in the head of the pancreas).
  • Unexplained weight loss.
  • Abdominal pain radiating to the back.
  • Nausea and vomiting.
  • Pale stools and dark urine (due to obstructive jaundice).
  • Recent onset diabetes.
Investigations
  • Abdominal CT scan: mainstay for diagnosis and staging.
  • Endoscopic ultrasound (EUS) with fine-needle aspiration: for tissue diagnosis.
  • MRCP: to evaluate bile and pancreatic ducts.
  • CA19-9: tumour marker, though non-specific, can be elevated in pancreatic cancer.
Management
  • Surgical resection (Whipple procedure or distal pancreatectomy): the only curative option but applicable to a minority of cases.
  • Chemotherapy (e.g., gemcitabine, FOLFIRINOX).
  • Radiation therapy: in certain situations, often combined with chemotherapy.
  • Palliative care: for symptom management in advanced disease.
    • Stenting for bile duct obstruction.
    • Pain management.
Prognosis
  • Generally poor with a low 5-year survival rate due to late diagnosis in most cases.
  • Early detection and resection offer the best chance of long-term survival.
Complications
  • Metastasis, commonly to the liver.
  • Biliary obstruction leading to jaundice.
  • Thromboembolic events (e.g., deep vein thrombosis).
  • Ascites.

Prompt diagnosis and management are critical for patients with pancreatic cancer, as the prognosis is generally poor. A multi-disciplinary approach involving gastroenterologists, oncologists, and surgeons is essential for optimal care.

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